Preoperative botulinum toxin A injection in complex abdominal wall reconstruction- a propensity-scored matched study

Abstract

Introduction: Fascial closure during complex abdominal wall reconstruction (AWR) improves recurrence and wound infection rates. To facilitate fascial closure in massive ventral hernias preoperative Botulinum Toxin A (BTA) injection can be used.

Methods: 2:1 propensity-scored matching of patients undergoing AWR with and without BTA was performed based on BMI, defect width, and loss of domain using CT-volumetric analysis.

Results: 145 patients without BTA and 75 with BTA were comparable on hernia size (240vs251cm², p = 0.589) and hernia volume (1405vs1672cm³, p = 0.243). Patients with BTA had higher wound class (CDC≥3 37%vs13%, p < 0.001). Patients with BTA had a higher fascial closure rate (92%vs81%, p = 0.036), received more components separation (61%vs47%, p = 0.042), lower wound infection rate (12%vs26%,p = 0.019) and comparable recurrence rates (9%vs12%, p = 0.589). Recurrences occurred more often without complete fascial closure compared to patients with (33%vs7%, p < 0.001).

Conclusion: In patients with massive ventral hernias and severe loss of domain, preoperative BTA-injection improves fascial closure rates during AWR.

Keywords: Botulinum toxin a; Complex abdominal wall reconstruction; Hernia; Incisional; Recurrence; Ventral.